Abstract

Objective: Depression and post-traumatic stress disorder (PTSD) highly co-occur with alcohol use disorder (AUD). The comparative effects of noradrenergic vs. serotonergic antidepressants on drinking and depressive outcomes for those with AUD and co-occurring depression and/or PTSD are not well known.Methods: This study was an analysis of a randomized control trial of 128 patients with AUD who had co-occurring depression and/or PTSD. They were randomized to treatment with paroxetine vs. desipramine and naltrexone vs. placebo leading to four groups: paroxetine plus naltrexone, paroxetine plus placebo, desipramine plus naltrexone, and desipramine plus placebo. Outcomes were percent of drinking days, percent heavy drinking days, drinks per drinking day (Time Line Follow-back Method), and depressive symptoms (Hamilton Depression Scale). Groups compared were (1) depression without PTSD (depression group; n = 35), (2) PTSD without depression (PTSD group; n = 33), and (3) both depression and PTSD (comorbid group; n = 60).Results: There were no overall significant differences in drinking outcomes by medication in the entire sample, and no significant interaction when diagnostic groups were not considered. However, when diagnostic groups were included in the model, the interactions between time, diagnostic group, and medication (desipramine vs. paroxetine) were significant for percent drinking days (p = 0.042), and percent heavy drinking days (p = 0.036); paroxetine showed better drinking outcomes within the depression group, whereas desipramine showed better drinking outcomes in the PTSD and comorbid groups. Regarding depressive symptoms, paroxetine was statistically superior to desipramine in the total sample (p = 0.007), but there was no significant interaction of diagnostic group and medication. Naltrexone led to a decrease in craving but no change in drinking outcomes.Conclusions: The results of this study suggest that drinking outcomes may respond differently to desipramine and paroxetine depending on comorbid MDD and/or PTSD.

Highlights

  • Alcohol use disorder (AUD) is a common condition with a lifetime prevalence of approximately 30% in the general population [1] and highly prevalent in veterans [2]

  • When diagnostic groups were included in the model, the interactions between time, diagnostic group, and medication were significant for percent drinking days (p = 0.042), and percent heavy drinking days (p = 0.036); paroxetine showed better drinking outcomes within the depression group, whereas desipramine showed better drinking outcomes in the post-traumatic stress disorder (PTSD) and comorbid groups

  • Paroxetine was statistically superior to desipramine in the total sample (p = 0.007), but there was no significant interaction of diagnostic group and medication

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Summary

Introduction

Alcohol use disorder (AUD) is a common condition with a lifetime prevalence of approximately 30% in the general population [1] and highly prevalent in veterans [2]. Among veterans with AUD, there are high rates of comorbid psychiatric conditions, including MDD and PTSD [5, 6]. Comorbidity between MDD and PTSD is common; one recent study reported that 36.8% of veterans with co-occurring PTSD and AUD screened positive for MDD [7]. To date, very few studies have examined the effectiveness of pharmacologic treatments when there are multiple psychiatric diagnoses, such as co-occurring MDD and/or PTSD in those with AUD. Clinically it is often unclear whether treatments which have been developed in individuals without the comorbid condition are effective in “real world” clinical settings where comorbid conditions are often the rule rather than the exception [11]

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